Spinal implant

ABSTRACT

An interbody spinal implant for implantation in a disc space between adjacent vertebral bodies, and an insertion instrument facilitating such implantation is provided. The spinal implant includes a body portion and an extended end portion, where at least the body portion can include a biconvex upper and lower surfaces. And the insertion instrument is engageable to a proximal end portion of the interbody spinal implant to facilitate insertion of the interbody spinal implant into the disc space.

The present application is a continuation of U.S. application Ser. No.16/917,969, filed Jul. 1, 2020, which is hereby incorporated byreference herein in its entirety.

FIELD

The present technology generally relates to an interbody spinal implantfor implantation in a disc space between adjacent vertebral bodies, andan insertion instrument facilitating such insertion.

BACKGROUND

Conventional interbody spinal fusion implants have been used tofacilitate spinal fusion between adjacent vertebral bodies across a discspace. One or more of the conventional interbody spinal implants havebeen inserted into the disc space such that an upper surface thereofcontacts an upper one of the adjacent vertebral bodies and a lowersurface thereof contacts a lower one of the adjacent vertebral bodies.The vertebral bodies are composed of cancellous bone surrounded by alayer of cortical bone. The cortical bone is harder than the cancellousbone, and the cortical bone is thickest around the perimeters of theendplates. Thus, the bone of endplates of the adjacent vertebral bodiesis softer near the center of the endplates, and is harder around theperimeter of the endplates. Depending on the position of theconventional interbody spinal implants within the disc space, suchconventional interbody spinal fusion implants can potentially subsideinto the endplates of the upper one and the lower one of the adjacentvertebral bodies. Therefore, there is a need for interbody spinalimplants configured to engage substantial portions of the perimeters ofthe endplates of the adjacent vertebral bodies to limit suchsubsistence, and there is a need for an insertion instrumentfacilitating such implantation.

SUMMARY

The techniques of this disclosure generally relate to an interbodyspinal implant for implantation in a disc space between adjacentvertebral bodies, and an insertion instrument facilitating suchimplantation.

In one aspect, the present disclosure provides an interbody spinalimplant for implantation into a disc space between an upper vertebralbody and a lower vertebral body, the implant including a body portionhaving a proximal first end, an opposite distal second end, a proximalend surface at and adjacent the proximal first end, an upper surface, alower surface, a first lateral side surface, a second lateral sidesurface, and a first mid-longitudinal axis extending through theproximal first end and the distal second end of the body portion, theupper surface and the lower surface each being at least in part arcuatein a first plane perpendicular to the first mid-longitudinal axis, theupper surface and the lower surface each being at least in part arcuatein a second plane extending along the first mid-longitudinal axis andperpendicular to the first plane, and the proximal end surface beingarcuate in a third plane extending along the first mid-longitudinal axisand perpendicular to the first plane; and an extended end portion havinga proximal first end, an opposite distal second end, a distal endsurface, an upper surface, a lower surface, a first lateral sidesurface, a second lateral side surface, and a second mid-longitudinalaxis extending through the proximal first end and the distal second endof the extended end portion, the proximal first end of the extended endportion being collocated with the distal second end of the body portion,and the second mid-longitudinal axis being transverse to the firstmid-longitudinal axis, where the upper surface and the lower surfacebeing arcuate in the first plane and the second plane provides forbiconvex configurations adapted to contact endplates of the uppervertebral body and the lower vertebral body, respectively.

In one aspect, the present disclosure provides interbody spinal implantincluding a body portion having a proximal first end, an opposite distalsecond end, a proximal end surface at and adjacent the proximal firstend, an upper surface, a lower surface, a first lateral side surface, asecond lateral side surface, and a first mid-longitudinal axis extendingthrough the proximal first end and the distal second end of the bodyportion, the upper surface and the lower surface each being at least inpart arcuate in a first plane perpendicular to the firstmid-longitudinal axis, the upper surface and the lower surface eachbeing at least in part arcuate in a second plane extending along thefirst mid-longitudinal axis and perpendicular to the first plane, andthe proximal end surface being arcuate in a third plane extending alongthe first mid-longitudinal axis and perpendicular to the first plane;and an extended end portion having a proximal first end, an oppositedistal second end, a distal end surface, an upper surface, a lowersurface, a first lateral side surface, a second lateral side surface,and a second mid-longitudinal axis extending through the proximal firstend and the distal second end of the extended end portion, the proximalfirst end of the extended end portion being collocated with the distalsecond end of the body portion, the second mid-longitudinal axis beingtransverse to the first mid-longitudinal axis, and portions of theextended end portion being located on each side of a fourth planeextending along the second lateral side surface.

In one aspect, the present disclosure provides an interbody spinalimplant including a body portion having a proximal first end, anopposite distal second end, a proximal end surface at and adjacent theproximal first end, an upper surface, a lower surface, and a firstmid-longitudinal axis extending through the proximal first end and thedistal second end of the body portion, the upper surface and the lowersurface each being at least in part arcuate in a first planeperpendicular to the first mid-longitudinal axis, and the proximal endsurface being arcuate in a third plane extending along the firstmid-longitudinal axis and perpendicular to the first plane; and anextended end portion having a proximal first end, an opposite distalsecond end, a distal end surface, an upper surface, a lower surface, anda second mid-longitudinal axis extending through the proximal first endand the distal second end of the extended end portion, the proximalfirst end of the extended end portion being collocated with the distalsecond end of the body portion, the second mid-longitudinal axis beingtransverse to the first mid-longitudinal axis, and portions of theextended end portion being located on each side of a fourth planeextending along the second lateral side surface.

The details of one or more aspects of the disclosure as set forth in theaccompanying drawings and the description below. Other features,objects, and advantages of the techniques described in this disclosurewill be apparent from the description and drawings, and from the claims.

BRIEF DESCRIPTION OF DRAWINGS

FIG. 1 is a side, top, perspective view that illustrates an interbodyspinal implant according to a first embodiment of the presentdisclosure;

FIG. 2 is a top, plan view of the spinal implant of FIG. 1;

FIG. 3 is a top, plan view of the spinal implant of FIG. 1 in positionon a lower one of adjacent vertebral bodies in a disc space;

FIG. 4 is a top, plan view that illustrates interbody spinal implantsaccording to a second embodiment of the present disclosure in positionson a lower one of adjacent vertebral bodies in a disc space;

FIG. 5 is a top, rear, perspective view that illustrates insertion ofthe spinal implant of FIG. 1 into position relative to a lower one ofadjacent vertebral bodies in a disc space using a first embodiment of aninsertion instrument of the present disclosure;

FIG. 6 is a top, rear, perspective view that illustrates insertion ofthe spinal implants of FIG. 4 into position relative to a lower one ofadjacent vertebral bodies in a disc space using the insertion instrumentof FIG. 5; and

FIG. 7 is a top, rear, perspective view that illustrates insertion ofthe spinal implants of FIG. 4 into position relative to a lower one ofadjacent vertebral bodies in a disc space using a second embodiment ofan insertion instrument of the present disclosure.

The details of one or more aspects of the disclosure are set forth inthe accompanying drawings and the description below. Other features,objects, and advantages of the techniques described in this disclosurewill be apparent from the description and drawings, and from the claims.

DETAILED DESCRIPTION

An interbody spinal implant according to one embodiment of the presentdisclosure is generally referenced by the numeral 10 in FIGS. 1-3 and 5.The spinal implant 10 is generally shaped like a hockey stick, and isconfigured for insertion into a disc space between adjacent vertebralbodies. The general hockey-stick shape of the spinal implant 10 isafforded by a body portion 12 and an extended end portion 14 thatextends outwardly from the body portion 12.

As depicted in FIGS. 1 and 2, the body portion 12 includes a proximalend 20, an opposite distal end 22, and a mid-longitudinal axis L₁extending through the proximal end 20 and the distal end 22, and theextended end portion 14 includes a proximal end 24, an opposite distalend 26, and a mid-longitudinal axis L₂ extending through the proximalend 24 and the distal end 26. Furthermore, the distal end 22 of the bodyportion 12 and the proximal end 24 of the extended end portion 14 can becollocated with one another.

The body portion 12, as depicted in FIG. 1, includes a proximal endsurface 30, an upper surface 32, a lower surface 34, a first lateralside surface 36, and a second lateral side surface 38. As discussedbelow, the upper surface 32 and/or the lower surface 34 can be bowedoutwardly and have generally biconvex shapes to generally match thesurrounding anatomy after implantation. Furthermore, the first lateralside surface 36 and/or the second lateral side surface 38 also can bebowed outwardly with convex shapes to generally match the surroundinganatomy after implantation. An optional elongated aperture 40 can extendthrough the body portion 12 between the upper surface 32 and the lowersurface 34. The elongated aperture 40 can be used to facilitate bonegrowth through the spinal implant 10 between the adjacent vertebralbodies to facilitate spinal fusion. The body portion 12 (as well as theextended end portion 14) also can be made of a porous or semi-porousmaterial to facilitate bone growth into the spinal implant 10 from theadjacent vertebral bodies to facilitate spinal fusion. Furthermore, theproximal end surface 30 can be the trailing end of the spinal implant10, and the proximal end surface 30, the first side surface 36, and thesecond side surface 38 extend between the upper surface 32 and the lowersurface 34.

The proximal end surface 30 (FIGS. 1 and 2) can be arcuate in firstplanes that are parallel to the mid-longitudinal axis L₁ andperpendicular to portions of the first side surface 36 and the secondside surface 38. For example, the proximal end surface 30 is shaped as aportion of a circle in one of the first planes that extends along themid-longitudinal axis L₁ and bisects the body portion 12 into an upperhalf and a lower half, and can be arcuate in other first planes that areparallel to the first plane bisecting the body portion 12. The arcuateshape of the proximal end surface 30 aids in preventing harm toanatomical structures adjacent to the spinal implant 10. Rather thanbeing circular, the proximal end surface 30 can have other arcuateshapes. In some instances, the proximal end surface 30 can have arcuatebulges in the first planes adjacent the first side surface 36 and/or asecond side surface 38.

The arcuate shape of the proximal end surface 30 aids in preventing harmto anatomical structures adjacent to the spinal implant. Furthermore, asdepicted in FIGS. 1 and 2, the proximal end surface 30 can include atool-engaging aperture 42 formed therein, the proximal end surface 30and/or the first side surface 36 can include a first tool-engagingrecess 44, and the proximal end surface 30 and/or the second sidesurface 38 can include a second tool-engaging recess 46. Thetool-engaging aperture 42 can include threads (not shown) to facilitateengagement with a complimentary structure provided on an insertion tool100. The first tool-engaging recess 44 can be formed in both theproximal end surface 30 and the first side surface 36, and the secondtool-engaging recess 46 can be formed in both the proximal end surface30 and the second side surface 38. Alternatively to the firsttool-engaging recess 44 and the second tool-engaging recess 46,positive, negative, or a combination of positive/negative features canbe formed on the proximal end surface 30, the first side surface 36, andthe second side surface 38 to facilitate engagement with complimentaryfeatures formed on the insertion tool 100.

The upper surface 32 and the lower surface 34 can each have convexshapes. To illustrate, the upper surface 32 and/or the lower surface 34can be convex in second planes that are aligned with themid-longitudinal axis L₁ and perpendicular to the first plane bisectingthe body portion 12, and/or can be convex in third planes transverse tothe mid-longitudinal axis and perpendicular to both the first planebisecting the body portion 12 and the second planes. The convexity ofthe upper surface 32 (which can be duplicated on the lower surface 34)is illustrated by a dashed line 50 and dashed lines 52 in FIG. 1, andsuch convexity can be described as being biconvex. The convexities ofthe upper surface 32 and the lower surface 34 facilitate engagement withportions of concave endplates of the adjacent vertebral bodies. Theupper surface 32 and/or the lower surface 34 can be smooth orsmoothened, or can include surface configurations such as a collectionof surface roughenings to facilitate insertion of the spinal implant 10into the disc space, and/or to facilitate bone ingrowth into the spinalimplant 10. For example, while still being biconvex, the upper surface32 and/or the lower surface 34 can include ratchetings that facilitateinsertion of the spinal implant 10 into the disc space. Furthermore,while still being biconvex, the upper surface 32 and/or the lowersurface 34 can be rough and porous to facilitate bone ingrowth into thespinal implant.

Additionally, the upper surface 32 and/or the lower surface 34 can beformed from a series or collection of surface configuration such asflats, convexities, concavities, and/or facets that together provide fora generally biconvex shape. To illustrate, a combination of convexitiesand concavities forming a generally biconvex shape could resemble thesurface of a golf ball. Such a generally biconvex shape of the uppersurface 32 and/or the lower surface 34 also can be formed by a series orcollection of various surface configuration such as bumps, spikes,teeth, and/or ridges in addition or alternatively to the above-discussedratchetings. Furthermore, such a generally biconvex shape of the uppersurface 32 and/or the lower surface 34 also can be formed from a seriesor collection of terraced features arranged in a stair-step fashion.Alternatively, the upper surface 32 and/or the lower surface 34 can beformed as concave bowls for receiving bone graft that can be moundedinto generally biconvex shapes.

The extended end portion 14, as depicted in FIG. 1, includes a distalend surface 60, an upper surface 62, a lower surface 64, a first sidesurface 66, and a second side surface 68. The distal end surface 60and/or the first side surface 66, like the first lateral side surface 36and/or the second lateral side surface 38, can be bowed outwardly withconvex shapes to generally match the surrounding anatomy afterimplantation. The extended end portion 14 resides on both sides of afourth plane that extends along the second side surface 38. Furthermore,the distal end surface 60, the first side surface 66, and the secondside surface 68 extend between the upper surface 62 and the lowersurface 64. The upper surface 62 and/or the lower surface 64 can besmooth or smoothened, or can include the above-discussed surfaceconfigurations. The upper surface 62 of the extended end portion 14 cansmoothly transition into the upper surface 32 of the body portion 12,the lower surface 64 of the extended end portion 14 can smoothlytransition into the lower surface 34 of the body portion 12, the firstside surface 66 of the extended end portion 14 can smoothly transitioninto the first side surface 36 of the body portion 12, and the secondside surface 68 of the extended end portion 14 can smoothly transitioninto the second side surface 38 of the body portion 12. For example, thesmooth transition between first side surface 66 and the first sidesurface 36 is formed by a convex transition 70, and the smoothtransition between the second side surface 68 and the second sidesurface 38 is formed by a concave transition 72.

In addition to the convex transition 70 and the concave transition 72,curved transitions can also be provided between the distal end surface60, and the first side surface 66 and the second side surface 68. Toillustrate, a first curved transition 74 can be provided between thedistal end surface 60 and the first side surface 66, and a second curvedtransition 76 can be provided between the distal end surface 60 and thesecond side surface 68. Depending on the orientation of the spinalimplant 10 during insertion, the distal surface 60, the first sidesurface 66, the first curved transition 74, or the second curvedtransition 76 can be the leading end surface.

The extended end portion 14 can be tapered such that the height thereofdecreases from the proximal end 24 to the distal end 26, or can bereverse-tapered such that the height thereof increases from the proximalend 24 to the distal end 26. The tapering of the extended end portion 14can be provided to accommodate the anatomy of the disc space and/orprovided to facilitate insertion of the spinal implant 10 into the discspace. For example, as depicted in FIG. 1, the extended end portion 14is reverse-tapered from the proximal end 24 to the distal end 26, andthe heights of the first side surface 66 and the second side surface 68can increase from the proximal end 24 to the distal end 26 of theextended end portion 14.

The upper surface 62 and/or the lower surface 64 can each be flattenedor have convex shapes like the upper surface 32 and the lower surface34. The upper surface 62 and/or the lower surface 64 can also have theabove-discussed series or collection of surface configurations. Toillustrate, in similar fashion to the upper surface 32 and the lowersurface 34, the upper surface 62 and/or the lower surface 64 can beconvex in planes aligned with and/or transverse to the mid-longitudinalaxis L₂ of the extended end portion 14. The upper surface 62 (FIG. 1)and the lower surface 64 are substantially flattened except for thesmooth transitions thereof into the upper surface 32 and the lowersurface 34 of the body portion 12. Given that the extended end portion14 has a reverse-taper from the proximal end 24 to the distal end 26,the upper surface 62 is angled upwardly from the proximal end 24, andthe lower surface 64 is angled downwardly from the proximal end 24.

When inserted into the disc space, the over-all shape of the spinalimplant 10 affords placement of portions thereof on or adjacent thestronger bone of the cortical rims of the adjacent vertebra. As depictedin FIGS. 3 and 5, the spinal implant 10 is positioned such that aportion of the extended end portion 14 adjacent the first side surface66 is positioned on a cortical rim C of a lower vertebral body V, and aportion of the body portion 12 adjacent the proximal end surface 30 isalso positioned on the cortical rim C of the lower vertebral body V. Thecortical rim C of the lower vertebral body V includes an anteriorportion 80, a first posterior portion 82, a second posterior portion 84,a first lateral portion 86, and a second lateral portion 88. The portionof the extended end portion 14, as depicted in FIGS. 3 and 5, rests on aportion of the anterior portion 80 of the cortical rim C. Furthermore,as depicted in FIGS. 3 and 5, the portion of the body portion 12 restson portions of the second posterior portion 84 and the second lateralportion 88 of the cortical rim C. The arcuate shape of the proximal endsurface 30 and the smooth transitions of the proximal end surface 30into the first lateral side surface 36 and a second lateral side surface38 serve in preventing harm to the anatomical structures adjacent to thespinal implant 10 by distributing the load of the spinal implant 10across the stronger bone of the cortical rim C over a larger area of thespinal implant 10, as well to generally approximate the curvature of thecortical rim C.

Although not shown, the spinal implant 10 would also contact similarlocations of a cortical rim of an upper vertebral body across the discspace from the lower vertebral body V. Given the placement of the spinalimplant 10, the arcuate shapes of the upper surface 62 and the lowersurface 64 facilitate the distribution of the load to the strongest boneof the vertebral bodies at the cortical rim C.

The insertion tool 100 can be used to facilitate positioning the spinalimplant 10 in the disc space. Furthermore, the spinal implant 10, asdepicted in FIG. 5, can be inserted into the disc space fromsubstantially lateral or substantially posterior directions as part of atransforminal lumber interbody fusion (TLIF) procedure or a posteriorlumbar interbody fusion (PLIF) procedure, respectively. The spinalimplant 10 could also be inserted from additional different insertiondirections, and with different positions for the tool-engaging aperture42, the first tool-engaging recess 44, the second tool-engaging recess46, or other engagement features, the spinal implant 10 could beinserted in different orientations relative to the insertion tool 100.For example, the tool-engaging aperture 42, the first tool-engagingrecess 44, the second tool-engaging recess 46, or other engagementfeatures could be provided on the extended end portion 14, and theinsertion tool 100 could be used to insert the spinal implant 10 at aninsertion orientation afforded by the different placement of theseengagement features.

One or more smaller spinal implants 10′ similar to the spinal implant 10and having similar features thereto can be used instead of the spinalimplant 10, and similar numerals will be used in describing the spinalimplants 10′. As depicted in FIGS. 4 and 6, a body portion 12′ has asimilar width to the body portion 12 and includes a proximal end surface30′, but is shorter than the body portion 12, and an extended endportion 14′ has similar dimensions as the extended end portion 14.

As depicted in FIGS. 4 and 6, when inserted into the disc space, thespinal implants 10′ are sized such that two spinal implants 10′ can bepositioned such that a first of the spinal implants 10′ is positioned onportions of the anterior portion 80, the first lateral portion 86, andthe first posterior portion 82 of the lower vertebral body V, and asecond of the spinal implants 10′ is positioned on the anterior portion80, the second lateral portion 88, and the second posterior portion 84of the lower vertebral body V. More specifically, a portion of theextended end portion 14′ of the first one of the spinal implants 10′rests on the anterior portion 80, a portion of the first one of thespinal implants 10′ at the connection between the body portion 12′ andthe extended end portion 14′ rests on the first lateral portion 86, anda portion of the body portion 12′ of the first one of the spinalimplants 10′ adjacent the proximal end surface 30′ rests on the firstposterior portion 82; and a portion of the extended end portion 14′ ofthe second one of the spinal implants 10′ rests on the anterior portion80, a portion of the second one of the spinal implants 10′ at theconnection between the body portion 12′ and the extended end portion 14′rests on the second lateral portion 88, and a portion of the bodyportion 12′ of the second one of the spinal implants 10′ adjacent theproximal end surface 30′ rests on the second posterior portion 84.

Although not shown, the spinal implant 10′ would also contact similarlocations of a cortical rim of the upper vertebral body across the discspace from the lower vertebral body V. Given the placement of the spinalimplant 10′, the arcuate shapes of the upper surface 32′ and the lowersurface 34′ facilitate the distribution of the load to the strongestpart of the vertebral bodies at the cortical rim C.

The insertion tool 100 also can be used to facilitate positioning thespinal implant 10′ in the disc space. Furthermore, the spinal implant10′, as depicted in FIG. 6, can be inserted into the disc space fromsubstantially lateral or substantially posterior directions as part of aTLIF procedure or a PLIF procedure, respectively. The spinal implant 10′could also be inserted from additional different insertion directions,and with different positions for the tool-engaging aperture 42′, thefirst tool-engaging recess 44′, the second tool-engaging recess 46′, orother engagement features, the spinal implant 10′ could be inserted indifferent orientations relative to the insertion tool 100. For example,the tool-engaging aperture 42′, the first tool-engaging recess 44′, thesecond tool-engaging recess 46′, or other engagement features could beprovided on the extended end portion 14′, and the insertion tool 100could be used to insert the spinal implant 10′ at an insertionorientation afforded by the different placement of these engagementfeatures.

The insertion tool 100, as depicted in FIGS. 5 and 6, includes an outershaft portion 102, an inner shaft portion 104, a head portion 106, amid-longitudinal axis L₃, an interior cavity (not shown), and a handleportion (not shown). The interior cavity extends through the outer shaftportion 102 and a portion of the head portion 106, and the inner shaftportion 104 is received within the interior cavity. Furthermore, thehandle portion is attached to the inner shaft portion 104, the innershaft portion 104 is rotatable with the interior cavity, and portions ofthe inner shaft portion 104 are moveable out of and into the interiorcavity via actuation of the handle portion. As discussed below, theinner shaft portion 104 includes an end portion 108 that can includethreads (not shown) for engaging the threads of the tool-engagingaperture 42, and can be extended and retracted relative to the headportion 106 to engage the spinal implants 10 and 10′.

The head portion 106, as depicted in FIG. 5, includes a first earportion 110, a second ear portion 112, a first prong 114, a second prong(not shown), a recess 118, a first concave end surface 120, and a secondconcave end surface 122. The first prong 114 is provided on the distalend of the first ear portion 110 and is configured to engage the firsttool-engaging recess 44; the second prong is provided on the distal endof the second ear portion 112 and is configured to engage the secondtool-engaging recess 46; the recess 118 is positioned between the firstear portion 110 and the second ear portion 112; and the first concaveend surface 120 and the second concave end surface 122 are configured tocontact at least portions of the proximal end surfaces 30 and 30′.

To engage the spinal implants 10 and 10′, the first prong 114 isreceived in the first tool-engaging recess 44, the second prong isreceived in the second tool-engaging recess 46, and a portion of theinner shaft portion 104 is extended through the recess 118 and the endportion 108 threaded into the tool-engaging aperture 42 via manipulationof the handle portion. After such engagement, the spinal implants 10 and10′ can be manipulated into positions within the disc space via theabove-discussed procedures. When the spinal implants 10 and 10′ areattached to the insertion instrument 100, the mid-longitudinal L₁ andthe mid-longitudinal axis L₃ are oriented in alignment with one another,and thus, insertion directions thereof can also be aligned with themid-longitudinal axes L₁ and L₃. The spinal implants 10 and 10′ can beseparated from the insertion tool 100 by reversing the order of theengagement. After separation, the insertion tool 100 can then be removedfrom the body of the patient.

As depicted in FIG. 7, an insertion instrument 100′ is provided thatoptionally does not include the first prong 114 and the second prong116. Like the insertion instrument 100, the insertion instrument 100′includes the first concave end surface 120 and the second concave endsurface 122. The spinal implants 10 and 10′ can be configured to includeone or more tool-engagement apertures (not shown) facilitatingengagement with corresponding engagement features provided on the innershaft portion 104. The one or more tool-engagement apertures can be indifferent locations than the tool-engaging aperture 40, and thesedifferent locations afford insertion directions of the implants 10 and10′ in orientations with the longitudinal axis L₁ of the body portions12 and 12′ being transverse to the longitudinal axis L₃ of the insertioninstrument 100′. In addition or alternatively to the above-discussedtool-engagement apertures, other engagement features can be configuredto facilitate engagement by an insertion tool at a first engagementangle to the spinal implants 10 and 10′, facilitate insertion of thespinal implants 10 and 10′ at a first insertion angle using theinsertion tool, facilitate release of the spinal implants 10 and 10′ bythe insertion tool, facilitate reengagement by the insertion tool at adifferent second engagement angle to the spinal implants 10 and 10′, andthen facilitate continued insertion of the spinal implants 10 and 10′ ata different second insertion angle using the insertion tool. Thisprocess could be continued or repeated as necessary using additionaldifferent engagement angles and insertion angle. And this process couldbe used to rotate or spin the spinal implants 10 and 10′ aroundanatomical features or into position within the disc space.

It should be understood that various aspects disclosed herein may becombined in different combinations than the combinations specificallypresented in the description and the accompanying drawings. It shouldalso be understood that, depending on the example, certain acts orevents of any of the processes of methods described herein may beperformed in a different sequence, may be added, merged, or left outaltogether (e.g., all described acts or events may not be necessary tocarry out the techniques). In addition, while certain aspects of thisdisclosure are described as being performed by a single module or unitfor purposes of clarity, it should be understood that the techniques ofthis disclosure may be performed by a combination of units or modulesassociated with, for example, a medical device.

I claim:
 1. A unitary interbody spinal implant comprising: a bodyportion having a proximal first end, an opposite distal second end, aproximal end surface at and adjacent the proximal first end, an uppersurface, a lower surface, a first lateral side surface, a second lateralside surface, and a mid-longitudinal axis extending through the proximalfirst end and the distal second end of the body portion, the uppersurface and the lower surface each being at least in part arcuate in afirst plane extending through the first lateral side and the secondlateral side and being perpendicular to the mid-longitudinal axis, theupper surface and the lower surface each being at least in part arcuatein a second plane extending parallel to the mid-longitudinal axis andbeing perpendicular to the first plane, the proximal end surface beingat least in part arcuate in a third plane at and adjacent anintersection of the mid-longitudinal axis with the proximal end surface,the third plane extending parallel to the mid-longitudinal axis andbeing perpendicular to the first plane, the proximal end surfaceextending from at least adjacent the first lateral side surface to atleast adjacent the second lateral side surface, and the first lateralside surface and the second lateral side of the body portion terminatingadjacent a fourth plane perpendicular to the mid-longitudinal axis ofthe body portion; and an extended end portion having a proximal firstend, an opposite distal second end, an upper surface, a lower surface, afirst lateral side surface, and a second lateral side surface, theproximal first end of the extended end portion being located adjacentthe distal second end of the body portion, and the first lateral sidesurface and the second lateral side surface each including planarportions extending toward the distal end surface at a different acuteangle relative to the fourth plane.
 2. The interbody spinal implant ofclaim 1, wherein the proximal end surface approximates a portion of acircle in the third plane.
 3. The interbody spinal implant of claim 2,wherein a first tool-engaging recess is formed in portions of at leastone of the proximal end surface and the first lateral side surface ofthe body portion, and a second tool-engaging recess is formed inportions of at least one of the proximal end surface and the secondlateral side surface of the body portion.
 4. The interbody spinalimplant of claim 1, wherein the upper surface and the lower surface ofthe body portion extend between the proximal first end and the distalsecond end.
 5. The interbody spinal implant of claim 1, furthercomprising an aperture extending through the body portion between theupper surface and the lower surface.
 6. The interbody spinal implant ofclaim 1, further comprising a first arcuate transition between the firstlateral side surface of the body portion and the first lateral sidesurface of the extended end portion, and a second arcuate transitionbetween the second lateral side surface of the body portion and thesecond lateral side surface of the extended end portion.
 7. Theinterbody spinal implant of claim 1, wherein the extended end portionincludes a reverse taper from the proximal first end to the distalsecond end thereof.
 8. The interbody spinal implant of claim 7, whereinthe extended end portion includes a first height adjacent the proximalfirst end thereof and a second height adjacent the distal second endthereof, the first height being shorter than the second height.
 9. Theinterbody spinal implant of claim 1, wherein a fifth plane extends alongthe second lateral side surface of the body portion, and portions of theextended end portion are disposed on each side of the fifth plane.
 10. Aunitary interbody spinal implant comprising: a body portion having aproximal first end, an opposite distal second end, a proximal endsurface at and adjacent the proximal first end, an upper surface, alower surface, a first lateral side surface, and a second lateral sidesurface, the upper surface and the lower surface each being at least inpart arcuate in a first plane extending through the first lateral sideand the second lateral side, the upper surface and the lower surfaceeach being at least in part arcuate in a second plane extending throughthe proximal first end and the distal second end and being perpendicularto the first plane, and the proximal end surface being at least in partarcuate in a third plane extending through the proximal first end andthe distal second end and being perpendicular to the first plane, andthe proximal end surface extending from at least adjacent the firstlateral side surface to at least adjacent the second lateral sidesurface; and an extended end portion having a proximal first end, anopposite distal second end, an upper surface, a lower surface, a firstlateral side surface, and a second lateral side surface, the proximalfirst end of the extended end portion being located adjacent the distalsecond end of the body portion, the first lateral side surface and thesecond lateral side surface each including planar portions extendingtoward the distal end surface at a different acute angle relative to afourth plane positioned between the body portion and the extended endportion, and portions of the extended end portion being located on eachside of a fifth plane extending along the second lateral side surface.11. The interbody spinal implant of claim 10, wherein the proximal endsurface approximates a portion of a circle in the third plane.
 12. Theinterbody spinal implant of claim 11, wherein a first tool-engagingrecess is formed in portions of at least one of the proximal end surfaceand the first lateral side surface of the body portion, and a secondtool-engaging recess is formed in portions of at least one of theproximal end surface and the second lateral side surface of the bodyportion.
 13. The interbody spinal implant of claim 10, furthercomprising a first arcuate transition between the first lateral sidesurface of the body portion and the first lateral side surface of theextended end portion, and a second arcuate transition between the secondlateral side surface of the body portion and the second lateral sidesurface of the extended end portion.
 14. The interbody spinal implant ofclaim 10, wherein the extended end portion includes a reverse taper fromthe proximal first end to the distal second end thereof.
 15. Theinterbody spinal implant of claim 14, wherein the extended end portionincludes a first height adjacent the proximal first end thereof and asecond height adjacent the distal second end thereof, the first heightbeing shorter than the second height.
 16. A unitary interbody spinalimplant comprising: a body portion having a proximal first end, anopposite distal second end, a proximal end surface at and adjacent theproximal first end, an upper surface, and a lower surface, the uppersurface and the lower surface each being at least in part arcuate in afirst plane extending through the proximal first end and the distalsecond end, and the proximal end surface being at least in part arcuatein a second plane extending through the proximal first end and thedistal second end and being perpendicular to the first plane; and anextended end portion having a proximal first end, an opposite distalsecond end, a distal end surface, an upper surface, and a lower surface,the proximal first end of the extended end portion being locatedadjacent the distal second end of the body portion, the first lateralside surface and the second lateral side surface each including planarportions extending toward the distal end surface at a different acuteangle relative to a third plane perpendicular to the first plane and thesecond plane, and portions of the extended end portion being located oneach side of a fourth plane extending along the second lateral sidesurface.
 17. The interbody spinal implant of claim 16, wherein theproximal end surface approximates a portion of a circle in the secondplane.
 18. The interbody spinal implant of claim 17, wherein a firsttool-engaging recess is formed in portions of at least one of theproximal end surface and a first lateral side surface of the bodyportion, and a second tool-engaging recess is formed in portions of atleast one of the proximal end surface and a second lateral side surfaceof the body portion.
 19. The interbody spinal implant of claim 16,wherein the extended end portion includes a reverse taper from theproximal first end to the distal second end thereof.
 20. The interbodyspinal implant of claim 19, wherein the extended end portion includes afirst height adjacent the proximal first end thereof and a second heightadjacent the distal second end thereof, the first height being shorterthan the second height.